Supervirus Adventures

A note from TheBody.com: The field of medicine is constantly evolving. As a result, parts of this article may be outdated. Please keep this in mind, and be sure to visit other parts of our site for more recent information!

Since the discovery of HIV back in the 1980s, most people have accepted the theory that a person could be infected more than once with different strains of the virus. Ongoing research into reinfection has never proven this theory. Various studies, quietly conducted and under-publicized over the years, failed to demonstrate how it could happen or remove all doubt as to whether it does or not. In fact, I am routinely asked during safer sex workshops whether or not reinfection happens. And I routinely shock the participants by telling them that there is no evidence whatsoever to support the theory.

I suspect the theory was born in the '80s as a means of promoting safer sex even between those who are already infected. If you're already infected, then safer sex is an option that can certainly prevent transmission of some other sexually transmitted diseases. That's true. But way back in the '80s and into the '90s, reinfection research wasn't telling us anything other than this: if you have HIV, you have HIV, and the first strain introduced to your body is the only one it seems to care anything about. It's almost like your body says, "HIV? No thanks, I already have that."

In 1999, the Centers for Disease Control and Prevention announced availability of funds for epidemiological and laboratory research studies to characterize reinfection with Human Immunodeficiency Virus. The purpose of the program was to "characterize the occurrence of reinfection with a second strain of HIV and determine whether reinfection has clinical relevance for the pathogenesis of HIV disease."

To receive funds, researchers had to address the following three questions:

Can naturally occurring reinfection with a second, genotypically distinct strain of HIV-1 be documented after initial infection has been established?

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(How often?) Does reinfection result in the emergence of a new predominant strain of HIV-1?

Is reinfection with a second strain of HIV-1 associated with clinical disease progression, emergence of resistance to antiviral drugs, or other adverse consequences?

I'll cut to the chase: A research group from Ottawa Hospital in Ontario, Canada, believe they have documented the first case in which an HIV-positive individual was infected with a second strain of the HIV virus. And they're calling it "superinfection." The individual cited by the researchers had been HIV-positive for eight years without exhibiting signs of serious disease progression. He had never taken any antiviral drugs. His doctors became concerned when his condition worsened dramatically and he was resistant to antiviral therapy (in other words, the "cocktail" didn't work for him).

In questioning the patient, doctors learned that just before his condition worsened, he had sexual contact with another HIV-positive person he had met at a clinic. The doctors compared samples of the man's original HIV and his current virus with samples from the second man to arrive at their conclusions, one of which is that drug resistance was also transferred to the first individual.

These conclusions were reported by Dr. Jonathan Angel on the final day of the 7th Annual Conference on Retroviruses and Opportunistic Infections back in February. Dr. Angel believes the patient's "superstrain" is resistant to all current HAART regimens, and leads to rapid advance of HIV disease in the infected person.

Dr. Angel (and possibly you) concludes that "Patient A was very likely infected with a resistant strain of HIV-1 by Patient B." And he goes on to say, "I think there's enough information here to raise awareness to say that this should be a public health issue whether we can prove it [to everyone's satisfaction]."

Before we all jump to the same conclusion, it must be noted that Dr. Angel has only discovered the likely superinfection once. One time only. And since this kind of research has been going on for over a decade now and this is the one and only documented case, and because it has yet to be confirmed by any further independent research, we would be better served by waiting for verification of Dr. Angel's study before mounting a massive public health campaign. If the media and the medical community start to put this superinfection story out there without appropriate follow-up evidence and documentation and it later proves to be a fluke, rest assured no one will bother to go back and correct the record (that's why Americans still think HIV is a gay disease). With so many myths associated with HIV disease, it's time for everybody -- the CDC, AIDS service organizations, infectious disease specialists, activists, all people living with HIV -- to demand immediate verification of "superinfection" theories and to hold accountable those who would choose to willfully spread misinformation about this theory.

If Dr. Angel's findings are confirmed, this would indeed be the first documented report of what appears to be infection of an HIV-1 supervirus in a person already infected with HIV-1. Or perhaps they'll discover, too, that our own antiviral regimens are creating superviruses in our bodies. Who knows? After all, there is plenty of evidence that people infected with HIV since the arrival of HAART regimens are developing strains of the virus resistant to drugs they've never even taken!

"Superinfection" has been a buzzword in AIDS awareness circles for about a year now. Buzzwords are dangerous. They are used predominantly by headline-grabbing researchers and lazy journalists who want to get noticed fast. Don't get sucked into this kind of irresponsible drama. It has long been debated whether or not reinfection happens. Now we're talking "superinfection." This little piece of Canadian research appears to offer a "yes" to that question, but further research is needed to understand the epidemiology and extent of the phenomenon.

While I still encourage HIV-positive individuals to continue having safer sex with their HIV-positive partners, I promote that to prevent transmission of other sexually transmitted diseases. On the basis of one report, I am simply not convinced yet this is some kind of doomsday HIV supervirus thing that calls for a lot of hysterical wailing and gnashing of teeth.

A note from TheBody.com: The field of medicine is constantly evolving. As a result, parts of this article may be outdated. Please keep this in mind, and be sure to visit other parts of our site for more recent information!

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